Type 1 Diabetes (T1D) affects an estimated one in three hundred young people in the U.S., with increasing annual incidence. It is primarily an autoimmune disease and is often associated with other serious autoimmune conditions such as Addison's, celiac, and thyroid diseases. Current diagnostic protocols use radioactivity-based assays, measuring multiple autoimmune markers individually. There is a need for the development of better tests to diagnose/predict who will develop T1D, and for monitoring disease progression and therapeutic responsiveness, especially once effective treatments to prevent or delay T1D become available. The completion of the proposed SBIR project, carried out in collaboration with Drs. Yu and Eisenbarth (Barbara Davis Center for Childhood Diabetes), will result in development of sensitive multiplexed assay panels with required sensitivity and specificity for identification of pre-diabetic or recent onset T1D cases, and detection of associated autoimmune diseases. These panels will use sensitive Meso Scale Diagnostics, LLC. (MSD) MULTI-ARRAY(R) detection technology and will use small volumes of patient blood samples to simultaneously detect multiple autoimmune responses. The arrays will incorporate an MSD(R) technology-based assay for pro-insulin and insulin auto-antibodies (IAA) developed by our collaborators that has been shown to outperform currently used IAA radioimmunoassay in multi-laboratory comparative studies. Following subsequent Phase II and III development, the assay panels will be suitable for widespread use with patient samples, providing high accuracy, reproducibility and throughput at significantly lower costs than current singleplex radioactivity-based methods with their inherent regulatory and radioactive waste management issues. The MSD assay format also lends itself to development of point of care assays, making the screening of large populations possible (e.g. in pediatricians' offices) when therapies for the prevention of diabetes enter clinical practice.